OMB Control Number: 2060-0482

 Expiration Date: 6/30/15

EPA Form # 5900-138, Revised 7/14

 

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

SALES OF CRITICAL USE METHYL BROMIDE 

TO END USERS ANNUAL REPORT (40 CFR 82.13)

NOTE: FORM MUST BE COMPLETED BY ANY COMPANY THAT PROVIDED METHYL BROMIDE GAS OR FUMIGATIONS TO CRITICAL USERS. 

FORM MUST BE COMPLETED BY A CENTRAL OFFICE ON BEHALF OF THEIR DIVISIONS; ONE FORM PER COMPANY.

SECTION 1 COMPANY IDENTIFICATION

1.1 Date of Submission 1.2 Year to Which This Report Applies

1.3 Original Submittal Re-submittal

1.4 Company Information

Company Name 

Street Address 

City State Zip Code 

1.5 Company Contact Identification

Reporting Company Contact Person 

E-mail Address 

Phone Number Fax Number 

1.6 Company Type 

(check all that apply) Distributor Third Party Applicator Producer Importer

1.7 Signature of Reporting Company Representative

I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached 

documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the 

submitted information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, 

including the possibility of fine and imprisonment.

Name 

Title 

Signature Date 

SEND COMPLETED FORMS TO: For U.S. Postal Service:

U.S. EPA

Stratospheric Protection Division

Office of Atmospheric Programs

Mail Code: 6205T

1200 Pennsylvania Avenue, NW

Washington, D.C. 20460

For Private Courier:

U.S. EPA

Stratospheric Protection Division

Office of Atmospheric Programs

Room 4355CC

1201 Constitution Avenue, NW

Washington, D.C. 20004

A company may assert a claim of confidentiality for information submitted in this form by clearly marking that information as confidential. Such information shall 

be treated in accordance with EPA’s procedures for information claimed as confidential at 40 CFR Part 2, Subpart B, and will only be disclosed by the means 

set forth in the subpart. If no claim of confidentiality accompanies the report when it is received by EPA, it may be made public without further notice to the 

company (40 CFR 2.203).

The public reporting and recordkeeping burden for this collection of information is estimated to average 1.3 hours per response. Send comments on the 

Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including 

through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 

Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.
 OMB Control Number: 2060-0482

 Expiration Date: 6/30/15

EPA Form # 5900-138, Revised 7/14

 

 U.S. Environmental Protection Agency

 STRATOSPHERIC OZONE PROTECTION PROGRAM

CLASS I CONTROLLED SUBSTANCE

METHYL BROMIDE

SALES OF CRITICAL USE METHYL BROMIDE 

TO END USERS ANNUAL REPORT (40 CFR 82.13)

SECTION 2 SALES DATA

2.1 Company Name

2.2 Critical Use Methyl Bromide (newly produced or imported) 

sold (active ingredient only)*

Pre-Plant (kg) 

Post-Harvest (kg) 

Year-End Inventory Calculation

2.3.A Beginning Inventory of Critical Use Methyl Bromide from 

Prior Control Periods, if any (NOT pre-phaseout stocks). 

Note: This is the same amount as the previous control 

period’s ending inventory.*

Pre-Plant (kg) 

Post-Harvest (kg) 

2.3.B Critical Use Methyl Bromide Bought this Year (only new 

production/import, NOT pre-phaseout stocks)*

Pre-Plant (kg) 

Post-Harvest (kg) 

2.4 Critical Use Methyl Bromide Sold to an Entity Other than a 

Critical User (e.g., Distributor, Third Party Applicator)*

Pre-Plant (kg) 

Post-Harvest (kg) 

2.5 Year-End Inventory – Critical Use Methyl Bromide Not Sold 

In Reporting Year (2.3.A + 2.3.B – 2.2 – 2.4)*

Pre-Plant not sold by year end (kg) 

Post-Harvest not sold by year end (kg) 

2.6 Name(s) of Company(ies) for which Newly Produced Critical Use Methyl Bromide is Being Held and Associated 

Amount (kg) Held for Each (excluding end-users)

Company Name: Pre-Plant (kg): Post-Harvest (kg): 

Company Name: Pre-Plant (kg): Post-Harvest (kg): 

Company Name: Pre-Plant (kg): Post-Harvest (kg): 

NOTE: COMPLETE THE PRE-2005 METHYL BROMIDE STOCKS REPORT FOR QUANTITIES OF METHYL BROMIDE OWNED THAT WAS

PRODUCED/IMPORTED BEFORE JANUARY 1, 2005.

*If none, enter 0. Do not leave blank.